Atopic outcomes at 2 years in the CORAL cohort, born in COVID-19 lockdown.

INTRODUCTION: The CORAL study is a cohort of infants born during the first weeks of the first SARS-CoV-2 (COVID-19) lockdown. This cohort has had lower antibiotic exposure, higher breastfeeding rates and lower infection rates, especially in the first year of life. We hypothesized that the altered early-life environment of infants born during lockdown would change the incidence of allergic conditions. METHODS: This longitudinal, observational study followed 365 infants born between March and May 2020 from enrolment to the age of 2 years. Infants attended three research appointments at 6-, 12-, and 24-months and completed detailed questionnaires. At research appointments, children had skin prick testing, and atopic dermatitis (AD) assessment. Statistical analysis focused on changes within the group at different time points, the influence of specific environmental factors on allergic risk and compared the incidence of atopic conditions with a pre-pandemic Irish infant cohort, BASELINE. RESULTS: AD was more common in CORAL group at both 12 (26.5% vs. 15.5%; p < .001) and 24 months (21.3% vs. 15.9%; p = .02) compared with pre-pandemic BASELINE cohort. Within the CORAL group, those with AD at both 12- and 24-month appointments had a more severe AD phenotype associated with a higher risk of allergic sensitization. There was less milk (0% vs. 1%; p = .09), peanut (0.6% vs. 1.8%; p = .3), and egg allergy (0% vs. 2.9%; p < .001) in the CORAL group at 24 months compared with the BASELINE cohort. Aeroallergen sensitization increased between 12 and 24 months in the CORAL cohort (1.5% vs. 8.9%; p < .001), as did parent-reported wheezing episodes (9% vs. 24%; p < .001). CONCLUSIONS: Despite higher AD incidence in the CORAL cohort, the incidence of food sensitization and allergy are lower than expected pre-pandemic rates possibly reflecting the early introduction and maintenance of dietary allergens enhanced by changes in infant infections, antibiotic use, and breastfeeding in the first 2 years of life in the group. These beneficial effects of the lockdown could be outweighing the expected risk of less early-life microbial encounters outlined by the hygiene hypothesis.

Increased food diversity in the first year of life is inversely associated with allergic outcomes in the second year.

BACKGROUND: The evidence on the relationship between diet diversity in early life and allergic outcomes was few and inconsistent. We sought to determine the association of food diversity in the first year of life with allergic outcomes in the second year. METHODS: Two thousand two hundred fifty-one mother-infant pairs from Tongji Maternal and Child Health Cohort (TMCHC) were involved in the study. Information on complementary foods introduction was obtained by telephone interview at 6- and 12-month postpartum follow-up. Any doctor-diagnosed allergic diseases in the second year were recorded at 2-year postpartum follow-up. Food allergies in infancy were assessed and self-reported by mothers at each postpartum follow-up. Multivariable logistic regression was used to examine the effect of food diversity at 6 and 12 months of age on later allergic diseases and food allergy. RESULTS: A total of 135 (6.0%) infants reported allergic diseases at between 1 and 2 years of age. Independent of food allergy history of infants and other potential confounders, less food diversity at 6 months of age was associated with increased risk of later allergic diseases (OR 2.17, 95% CI 1.04-4.50 for 0 vs. 3-6 food groups). By 12 months of age, significant inverse associations with later allergic diseases (OR 2.35, 95% CI 1.03-5.32 for 1-5 vs. 8-11 food groups, and OR 1.98, 95% CI 1.16-3.37 for 6-7 vs. 8-11 food groups) and food allergy (OR 2.10, 95% CI 1.29-3.42 for 1-5 vs. 8-11 food groups) were observed. Children with higher food diversity in both periods had the lowest risk of allergic diseases during the second year of life. CONCLUSIONS: A more diverse diet within the first year of life was associated with reduced risk of allergic diseases at 1-2 years of age. Introducing higher diversity of foods from 6 to 12 months of age might be an effective strategy to improve the allergy outcomes of infants in later life.

Effects of traffic-related air and noise pollution exposure on allergic diseases in the elderly: an observational study.

INTRODUCTION: Traffic-related air and noise pollution are important public health issues. The aim of this study was to estimate their effects on allergic/respiratory outcomes in adult and elderly subjects. MATERIALS AND METHODS: Six hundred and forty-five subjects living in Pisa (Tuscany, Italy) were investigated through a questionnaire on allergic/respiratory symptoms and diseases. Traffic-related air pollution and noise exposures were assessed at residential address by questionnaire, modelled annual mean NO2 concentrations (1 km and 200 m resolution), and noise level over a 24-h period (Lden). Exposure effects were assessed through logistic regression models stratified by age group (18-64 years, ≥65 years), and adjusted for sex, educational level, occupational exposure, and smoking habits. RESULTS: 63.6% of the subjects reported traffic exposure near home. Mean exposure levels were: 28.24 (±3.26 SD) and 27.23 (±3.16 SD) µg/m3 for NO2 at 200 m and 1 km of resolution, respectively; 57.79 dB(A) (±6.12 SD) for Lden. Exposure to vehicular traffic (by questionnaire) and to high noise levels [Lden ≥ 60 dB(A)] were significantly associated with higher odds of allergic rhinitis (OR 2.01, 95%CI 1.09-3.70, and OR 1.99, 95%CI 1.18-3.36, respectively) and borderline with rhino-conjunctivitis (OR 2.20, 95%CI 0.95-5.10, and OR 1.76, 95%CI 0.91-3.42, respectively) only in the elderly. No significant result emerged for NO2. CONCLUSIONS: Our findings highlighted the need to better assess the effect of traffic-related exposure in the elderly, considering the increasing trend in the future global population's ageing.

Global population is ageing.Allergic diseases are globally widespread even on adult population.The susceptibility due to ageing may increase the impact of air pollution on the elderly.Traffic-related air and noise pollution affects allergic status of the elderly.

Prenatal Intake of Vitamins and Allergic Outcomes in the Offspring: A Systematic Review and Meta-Analysis.

BACKGROUND: Allergic diseases have seen a rise worldwide, with children suffering the highest burden. Thus, early prevention of allergic diseases is a public health priority. OBJECTIVE: To synthesize the evidence from randomized controlled trials (RCTs) assessing the effect of vitamin interventions during pregnancy on developing allergic diseases in offspring. METHODS: We searched CENTRAL, MEDLINE, SCOPUS, World Health Organization's International Clinical Trials Registration, E-theses, and Web of Science. Study quality was evaluated using Cochrane's risk of bias tool. Included RCTs had a minimum of 1-month follow-up postgestation. RESULTS: A total of 5 RCTs met the inclusion criteria, including 2456 children who used vitamins C + E (1 study), vitamin C (1 study), and vitamin D (3 studies) compared with placebo/control. Two studies were judged to have a high risk of bias for performance bias or a high rate of loss to follow-up. All were rated as low risk of bias for blinding of outcome assessment. We did not perform meta-analysis with vitamin C or vitamin C + E studies due to high heterogeneity between the 2 included studies. However, we did conduct a meta-analysis with trials on vitamin D (including 1493 children) and the results showed an association between the prenatal intake of vitamin D and the risk of developing recurrent wheeze in offspring (relative risk (RR), 0.812; 95% CI, 0.67-0.98). CONCLUSIONS: The current evidence suggests that prenatal supplementation of vitamin D might have a beneficial effect on recurrent wheezing in children. Longer-term follow-up of these studies is needed to ascertain whether this observed effect is sustained. There is lack of evidence on the effect of other vitamins for the prevention of respiratory and/or allergic outcomes.